C4-5 / C5-6 Foraminal Stenosis -- Deltoid & Serratus Anterior Paralysis

As the title reads, I've managed to strain my neck to the point of causing 4 cervical discs to bulge with 2 being significant enough to protrude against the nerves. Aside from causing a significant degree of unrelenting pain, it's also paralyzed the deltoid and serratus anterior muscles on my left side leaving me unable to raise my arm to touch the top of my head or hold any strength and stability while reaching out (like putting a water bottle down on a table). ~14 months ago I was involved in a vehicle accident and was lucky to be able to walk out of the hospital hours later. A follow-up visit to my usual Ortho determined that everything was OK, and I'd be able to resume activity after a short bit of rest. What I was unaware of was the fact that I'd yoked the absolute hell out of my neck, and for the past year I've had a stiff straight neck with little to no curvature (what you may call Military Neck). This hadn't caused me any pain or discomfort or any reason to be alarmed or to be made aware of it. 2 weeks ago, following a week of grueling boulder sessions end-capped by a weekend OCR, a simple morning dead-hang was the straw that broke the camel's neck. Within 5 minutes the pain set in and 3 days later the muscles were paralyzed. I've consulted with my ortho, PT, a spine specialist, and a chiro, and given my MRI results they all are of the mind that it's non-surgical (the protrusion isn't severe enough to warrant it) and that I should be seeing improvement and return of function after 8-12 weeks with continued rest and proper PT of the shoulder. It's comforting that they're all pointing in the same direction with no conflicting opinions or urgency to push surgery or even injections, but in my shoes I can't help but be worried as with the pain & paralysis the seconds feel like hours. I've been through recoveries before so I know how to play the waiting game, but the possibility of permanent muscle paralysis is new and it's a harrowing thought that's hard to shake. Has anyone been through this or similar? What did the recovery timeline and process look like, and was there any return of function?

Thanks for sharing. Is there any legal recourse from the car accident so u can be compensated through an insurance settlement?

Highly unlikely, since I didn't chase down the whiplash or get an MRI within any reasonable time frame to the accident. Immediately following the accident I was more concerned with my sprained sternoclavicular joint (which I had to annoyingly beg the hospital to xray, my clavicle looked more broken than it did when I had actually broken it..). My neck pain subsided in 2 or 3 days when the muscles finally calmed down, and that was the last of it until now. It would be tough to claim this is a result of that, not enough of a medical paper trail - although this definitely is fallout from that accident. Cautionary tale to get your neck 100% cleared, I guess.

Definitely curious to hear from anyone out there that's had any experience with muscle paralysis due to nerve pinching. Maybe about once per day so far the deltoid will spasm for a few seconds, and a few days ago for about 5 seconds it felt like someone stabbed a needle into my ribs where the serratus anterior muscles sit. These are signs, good ones I hope, that at least some form of innervation is occurring to the muscles.

I would look into it further. Maybe the xray shows some of your neck too. And there may be legal precedent for whiplash that shows up later as it is not a straightforward injury. 

Yes, I have similar issues and have dealt with chronic pain for about 10 years from herniated cervical discs. I wrote about my issues in another post on MP if you check my history. It took 2-3 years for me to really get my pain under control, but I don’t know if that is normal.

Did your ortho refer you to a non-surgical specialist that can do nerve conduction tests and nerve block injections? Those doctors often have long wait times to be seen and have many tools that don’t involve surgery.

Seems like everyone’s experiences with these issues are different. One mistake I have made more than once is not sticking with PT and yoga when I was feeling good and thought I was past the problem. In the acute stage of pain, I try and focus on soft tissue treatment and other non-surgical interventions to get to a place where I can handle exercises that address the muscular issues. 

My Ortho and PT are a kind of combined entity, and while I trust them for most everything they aren't really the go-to folks for neck/spine injuries. Instead, I had been referred to a very well regarded spine specialist by my chiro, one who offers more non-surgical solutions. A nerve block injection is on the table but it wasn't pushed as something that would be necessary for recovery - just as something for the pain if it were to get to that point. I would be curious to speak with one of the more surgery-happy docs just to get their opinion on it, because I do at times feel that the other 4 lean too deeply into non-surgical methods that it wouldn't be an option they would suggest if there was a possibility it was needed. My worry is that if I wait too long sitting in non-surgical recovery, and it doesn't actually improve at all during that time, that I'll have let it go too long and cause lasting damage to the nerve. Maybe a visit to a neurologist would be a smart move.

Did you experience temporary paralysis with your disc herniations, or was it purely pain, maybe accompanied with pins & needles?

I had what felt like fire going through my neck down my arm into my hand. My thumb and pointer finger were completely numb for a long time, and my tricep had atrophy. My tricep was so weak the orthopedic surgeon had to keep me from hitting my face on the wall when he had me do a one hand standing push up from an arm’s length away from the wall.

The orthopedic surgeon didn’t recommend fusion based on the MRI, and the herniations were too close to the spinal column for a microdiscectomy. I’m planning to avoid surgery for as long as I can since once you start fusing vertebrae, it puts pressure on the surrounding vertebrae all but guaranteeing future surgeries. Being in my 20s when this started, I wanted to avoid that.

I use an orthopedic group with a connected surgery center, so it’s easy to get multiple opinions and make informed decisions about treatment options.

There is a lot of information out there that can help you ask informed questions as well. I would suggest writing down your questions before going into the consultation since it’s easy to get overwhelmed and forget what you wanted answered. Here’s a good start https://www.ncbi.nlm.nih.gov/books/NBK546618/ 

Lots of great information on that page, thank you for pulling that up. Some relevant takeaways:

• C3, C4 Nerve – vague neck, and trapezial tenderness, and muscle spasms

• C5 Nerve – neck, shoulder, and scapula pain. Lateral arm paresthesia. Primary motions affected include shoulder abduction and elbow flexion. May also observe weakness with shoulder flexion, external rotation, and forearm supination. Diminished biceps reflex.

• C6 Nerve – neck, shoulder, and scapula pain. Paresthesia of the lateral forearm, lateral hand, and lateral two digits. Primary motions affected include elbow flexion and wrist extension. May also observe weakness with shoulder abduction, external rotation, and forearm supination and pronation — diminished brachioradialis reflex.

Most cases of acute spinal injury or herniation will resolve within the first four weeks, without any intervention.
Pain, restricted motion, and radiculopathy that result from a herniated disc typically subside on their own over six weeks in the majority of patients
In approximately one-third of patients, symptoms will remain persistent despite non-operative intervention. If symptoms last longer than six weeks, it becomes less likely that symptoms will improve without the need for surgical intervention.
If conservative therapy fails or severe neurological compromise is present, a referral to a surgeon is the next step.

It's been 2 weeks at this point, and the pain has been decreasing a bit since it reached its peak 3 days after onset. Possibly over the course of the next 2 weeks I should start seeing some improvement. By the 6 week mark, in 4 weeks, I should try to already have a plan laid out for surgery if I want to stay ahead of it.

Hi John, have you had any updates regarding the deltoid mobility? Going through something very similar where due to a disc herniation at the C4-C5 level I've lost most of the motor function in my deltoid. 

According to my MRI I have severe C6-7 stenosis. According to any normal function tests and the EMG, I’m fine.

I have 2 issues related to it. On my left side I get a sharp pain with overhead lifting. It’s minor and goes away quickly. The other is that I was doing a bunch of dips and inflamed it, to the point that I lost the ability to contract my left tricep for a month.

PT was pretty minor. Just easy mobility exercises. They had a neck stretcher which seemed pretty helpful. Everything went back to normal as time passed. Stenosis doesn’t go away. I’ll probably need a disc replacement in 10 years.

For your situation I would also suggest looking into a real neurosurgeon. Not for the surgery but these non-invasive “pain” docs are definitely biased. They can make a ton of money and not have to deal with insurance, they have a very good reason to want to treat you.

A neurosurgeon doesn’t actually want to cut you, especially if you’re under 50. They’re so busy that any money they make off you doesn’t affect their bottom line. They’re super experienced in reading MRI and interpreting EMG. And whatever you’ve got, they’ve seen it and worse a hundred times. I think a 20 minute visit with a PA for a neurosurgeon would probably be more helpful than all the other people you’ve mentioned.

Yes Eric there has been some upward progression. I was planning to give a more comprehensive write-up about it further down the road rather than drip feeding updates, but I'll drop some info on what's been going on because I know it's hell to not have much to read up on:

16 days after losing motor function I started feeling brief, faint buzzing sensations exactly where the affected nerve root is in my neck.

18 days after, during a PT session they manually worked my neck a bit and also pulled light traction by hand. Later that night I had a sudden tightening and spasm in my chest and shoulder, and noticed that when attempting shoulder flexion the deltoid was faintly twitching (it had been completely dead up until this point). Within the hour it felt like someone had taken a baseball bat to my shoulder and ribs, a different kind of pain than the stabbing pain I'd been feeling in my trapezius.

19 days and on, there have been small improvements day over day. The notable difference is that there is muscle innervation, but the affected muscles are still very twitchy and very weak. It did not take long for atrophy to set in, my left shoulder and upper arm are visibly smaller despite constant PT. I can perform shoulder abduction and flexion, but only to about 75% range of motion, and if I'm holding a water bottle I can only manage about 25% ROM above parallel. For these motions it feels like every other muscle in my shoulder and back is doing the heavy lifting. Forearm supination is about 90%, but it's a struggle to push it to that limit. At random times throughout the day there will be either burning or sharp pin-stabbing pains in the deltoid and serratus anterior, something that only started after getting motion back.

Today it's nearly 4 weeks since losing motor function, so big picture I've made a great deal of recovery without the need for surgery or any kind of injections. Your situation may look a bit different than mine, I only had disc bulging as opposed to a herniation. For overall relief from pain, having PT manually work my neck and pull traction (by hand, not with the medieval torture table) has provided immense and lasting relief.

Hey John,

I’m a PT and happy to weigh in- it’s not unheard of for folks to experience loss of muscle function secondary to disc herniation. If you’re still having a lot of motor weakness, I’d def talk to your doc about nerve conduction testing, and also whether a course of oral steroids and/or transforaminal epidural steroid injection (TFESI) would be appropriate. You might also ask your PT about going NMES for your deltoid to help combat the atrophy. If the manual traction they’re doing is helpful, they could also write you a script for a home unit. Unlike the “medieval torture” devices those are usually controlled by a hand pump.

PS. I see you’re from Maryland- I’m from there! I’m in Oregon now but still have a lot of contacts in MD if you ever want a PT second opinion feel free to reach out & I can see if I know anyone in your area.